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Breastfeeding problems: born at 31w 2d, current age 39w 3d

I'm new here and this is my first post, but I'm hoping someone can help me. I am also contacting local breastfeeding "experts" and looking up local LLL contacts, in addition to posting here.

I am having some breastfeeding challenges with my son. He is my first baby and was born prematurely (no known cause for this, my water broke and I went into labor, the doctors tried everything to stop it but it didn't work). He was born at 31 weeks, 2 days on January 2, 2007 and his name is Mario. Mario is currently 8 weeks old, real age, or 39 weeks, 3 days gestational age (due date was March 4). He was in the NICU at Good Samaritan Hospital for just shy of 5 weeks and came home on February 4. During his time in the NICU he only received breastmilk, which I have been pumping since he was born, and also he had fortifiers added to it, ending up at 24 calorie. In the NICU he was fed by gavage feeding initially, then breastfeeding and bottle feeding. I'm sure you are familiar with the routine.

Currently, he receives breastmilk, fortified to 24 calorie with Enfamil Enfasure, by bottle for half of his feedings and we are trying to breastfeed for the other half. His weight gain has been great (birth weight was 3 lbs, 14.6 oz and weight as of yesterday was 7 lbs 3 oz), plenty of wet and dirty diapers, etc. The goal is to get to the point where we can breastfeed all the time, only offering the bottle when we need to (such as if I need to go out and dad needs to feed the baby, when I go back to work in May, etc).

My problem is that he is having troubles with the breastfeeding and is showing a strong preference to the bottle (currently using Playtex VentAire bottles with Natural Latch nipples). I don't know if we have gone backward in terms of breastfeeding, or if I just was either ignorant or unaware of problems up until now. It seemed that he did so well in the beginning, but I don't know if he was appearing satisfied because he fell alseep right after or what. But, now, I am having problems getting him to latch on (he won't latch properly, will be manic and turn his head from side to side, cry, flail his arms, etc.), won't stay latched on, won't suck consistently, falls asleep at the breast or gets hysterical and won't suck, etc. I have tried several positions (cradle, football, side-lying), with and without the nipple shield, etc. I have tried swaddled and unswaddled (swaddled he gets cozy and falls alseep, unswaddled he can get manic and flail), different times of day and night, pumping for a few minutes before to encourage let-down, etc. Last night I had my husband get the Medela Supplemental Nurser and we are trying that so that he gets that immediate gratification when he sucks on the breast. I am still having problems getting him to latch and stay latched and suck in a good pattern. I know my supply is good because I pump regularly and get a good volume. We have a freezer full of pumped milk and I am way ahead of him in terms of the supply and demand ratio.

I am at the point of complete frustration here. I really want to be able to breastfeed him and have talked with people over the phone, read books, done online research, etc, but feel like I'm helpless and at a dead end. I am very willing to do whatever it takes to make this work, but don't know what that is at this point.

Re: Breastfeeding problems: born at 31w 2d, current age 39w 3d

do call your locall leaders there is a realy nice leader called Karen that runs a group for twins but I bet she would be willing to share what works with some of the premies she has worked with!
Its sounds like you are doing things right, trying the sns would be one thing to try!

Re: Breastfeeding problems: born at 31w 2d, current age 39w 3d

Just wanted to post a quick update.

I spoke with my son's pediatrician today at our check-up and let her know what's going on and she recommended the Center for Breastfeeding Medicine at Cincinnati Children's Hospital. So, I had planned to call and get information/schedule an appointment this afternoon. However, I had emailed Dr. Ballard yesterday and she called me today. She is involved with the center and we have an appointment with her tomorrow afternoon. So, hopefully we'll get some good info and start in the right direction.

Re: Breastfeeding problems: born at 31w 2d, current age 39w 3d

I would be interested in hearing what information you receive from the Dr. I am the mother of a 33 weeker who is now 4 months old and we still don't have the bfing thing down yet. She still gets to tired or impatient to finish a full feeding so I have become an exclusive pumper. But I keep hoping that one day it'll just click.

Re: Breastfeeding problems: born at 31w 2d, current age 39w 3d

Well, I went to my appointment today and will honestly say that I have mixed feelings about how it went. I don't think Mario was too happy with it either.

She first examined him and told me he has a high palate and a strong gag reflex, which may be interferring. The she did a pre-feed weight. She then had me breastfeed, with no aids, for about 20 minutes and did another weight. I swear I saw him sucking and swallowing, but the scale showed no weight gain. So, we did the same thing with the nipple shield, same results. Next we tried adding the SNS with the nipple shield. He only took about 30mL in total from that, but this was after being messed with and all of this for over an hour and he was getting fed up with it. Finally, she had me try bottle feeding him with a fast flow, orthodontic style nipple. He did not like that at all. I think the milk flow was too much for him and he choked. It's also very different than what we give at home.

So, the instructions she left me with were to do suck training several times a day using my finger, breastfeed as much as possible with the nipple shield and SNS, and use an ortho or NUK nipple when bottle feeding as a follow up to the breastfeeding. Her reason for that nipple was because of the high palate. She also told me to decrease the frequency of my pumping (I try for every 3 or so hours during the day - after he feeds, and after he feeds at night, which has been every 3-4 hours) as well as the duration so I decrease my supply some. Now, I know I am way ahead of things, but I always thought that too much was better than not enough. Though, I guess DH and I are talking about buying another freezer because the milk is taking over our big one in the basement and we're running out of room for mommy and daddy food.

Now, I really appreciate all of her help, but I don't think I will go back. I went into this appointment having done a lot of reading (books, internet, message boards, etc) and such and a lot of what she said went against what I have read. I know that there are many different opinions out there, and it's so hard to know what is "right" or best for us. I also didn't like the way she had me position him and I don't think he liked it either. I think that was evident in the fact that he didn't get anything straight breastfeeding. At home, when I use the nipple shield it is always full of milk when he pulls off, during our session there was none. He was doing a lot of non-nutritive sucking and not getting anything. I also don't think we'll be switching bottles. What we are using now works for him and it took a while to find one that would. I hate to change that, especially because my goal is to feed at the breast as much as possible. Also, I had read not to offer a bottle immediately after the breast and to make that a separate feeding so that the baby doesn't hold out for the bottle. She said she didn't think that would happen, but I think it does with my little guy.

So, bottom line is that I am taking this as more information, but not the end all and be all of things. I think I'll call some LLL consultants in my area tomorrow (it's kind of late now) and see about getting their advice as well.

I'm still very frustrated, but I am also stubborn and want this to work! If anyone has any other advice, I'd still love to hear it.

Re: Breastfeeding problems: born at 31w 2d, current age 39w 3d

I know its possiable to feed a baby with a high pallet... at least you have an answer to part of the problem!
do call your local leader!
heres a link to a moms story from new begingings who have a baby with clef pallet maybe that will help.

Re: Breastfeeding problems: born at 31w 2d, current age 39w 3d

Just another quick update to let you know how things are going. . .

Mario is now past his due date (March 4th) and is doing very well! He has not had a bottle since early Saturday morning (like around 4am) and is really "getting it" that food comes from "the boob" I am still using the SNS with the medium flow tubing. I really want him to get the idea that the food comes from Mommy and not get too frustrated. I am also still working with him on latching properly (his bottom lip tends to curl in and then he doesn't really suck on the whole nipple like he should). But, that is somewhat challenging trying to manage the SNS tubing and everything, though we are working through it. He is consistently taking between 4 and 4.5 oz per feeding now!

My plan now is to keep doing what I have been for the rest of this week and then start to try and wean him from the SNS. I can switch it to the slow flow tubing so he has to work a little harder for his food and then gradually wean him onto straight breastfeeding.

So, for now I'm still in my routine of feed the baby, "milk the mommy" as I like to call it I have a well stocked freezer of EBM, so no worries there!